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Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment
  1. Iain M Carey,
  2. Fay J Hosking,
  3. Tess Harris,
  4. Stephen DeWilde,
  5. Carole Beighton,
  6. Sunil M Shah,
  7. Derek G Cook
  1. Population Health Research Institute, St George's University of London, London, UK
  1. Correspondence to Dr Iain M Carey, Population Health Research Institute, St George's University of London, London SW17 0RE, UK; i.carey{at}


Background Annual health checks for adults with intellectual disability (ID) have been incentivised by National Health Service (NHS) England since 2009, but it is unclear what impact they have had on important health outcomes such as emergency hospitalisation.

Methods An evaluation of a ‘natural experiment’, incorporating practice and individual-level designs, to assess the effectiveness of health checks for adults with ID in reducing emergency hospital admissions using a large English primary care database. For practices, changes in admission rates for adults with ID between 2009–2010 and 2011–2012 were compared in 126 fully participating versus 68 non-participating practices. For individuals, changes in admission rates before and after the first health check for 7487 adults with ID were compared with 46 408 age-sex-practice matched controls. Incident rate ratios (IRRs) comparing changes in admission rates are presented for: all emergency, preventable emergency (for ambulatory care sensitive conditions (ACSCs)) and elective emergency.

Results Practices with high health check participation showed no change in emergency admission rate among patients with ID over time compared with non-participating practices (IRR=0.97, 95% CI 0.78 to 1.19), but emergency admissions for ACSCs did fall (IRR=0.74, 0.58 to 0.95). Among individuals with ID, health checks had no effect on overall emergency admissions compared with controls (IRR=0.96, 0.87 to 1.07), although there was a relative reduction in emergency admissions for ACSCs (IRR=0.82, 0.69 to 0.99). Elective admissions showed no change with health checks in either analysis.

Conclusions Annual health checks in primary care for adults with ID did not alter overall emergency admissions, but they appeared influential in reducing preventable emergency admissions.

  • Health inequalities
  • Epidemiological methods

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  • †Prior to publication, SMS died. His co-authors would like to pay a tribute to him, who as the principal investigator on this study successfully led it from inception

  • Contributors SMS conceived the study and led the project from inception until his death. IMC took over leadership on the project and is the guarantor for the paper. IMC undertook the analysis. All authors contributed to the development of the project methodology, interpretation of the results and drafting of the paper.

  • Funding This project was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 12/64/154).

  • Disclaimer The views and opinions expressed here are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.

  • Competing interests All authors had financial support from the National Institute for Health Research for the submitted work.

  • Ethics approval This study was approved by the Independent Scientific Advisory Committee (ISAC) evaluation of protocols of research involving CPRD data in July 2013.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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